Provider First Line Business Practice Location Address:
3367 HIGHWAY 119 N
Provider Second Line Business Practice Location Address:
SUITE C MAYKING MALL
Provider Business Practice Location Address City Name:
WHITESBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41858-7972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-633-4800
Provider Business Practice Location Address Fax Number:
606-633-7775
Provider Enumeration Date:
04/07/2006